GSS*EasyChart Registration

Name                 _____________________________________________________
Company Name         _____________________________________________________
Address              _____________________________________________________
City/Town            _____________________________________________________
Province/State       _____________________________________________________
Post/Zip code        _____________________________________________________
Country              _____________________________________________________
Daytime phone number _____________________________________________________
FAX number           _____________________________________________________
E-Mail               _____________________________________________________


Version of GSS*EasyChart that you are currently using: ___________________

Registered users receive a diskette containing the latest version of 
GSS*EasyChart and free technical support. Minor upgrades are free, that is, 
if you register version 1.xx, all upgrades until version 2.00 will be free 
(if downloaded - otherwise, shipping costs will be charged).

_______________________________________________________________________________


Quantity                                                              $US

GSS*EasyChart single licence (1 User) ($190.00 per piece)         _______
GSS*EasyChart academic version ($ 95.00 per piece)                _______


Subtotal                                                          _______

Shipping (check one)        (10 days)                     ( )       25.00
                            (2 days)                      ( )       40.00

Total                                                             _______



Payment:     ( ) Check*     ( ) Money Order*     ( ) Company Purchase Order
             ( ) American Express

* In US Dollars drawn on a US bank

Credit card number    ___________________________________________________
Expiration date       ___________________________________________________
The name as it
appears on the card   ___________________________________________________
Signature of the card 
owner                ____________________________________________________


Mail or Fax this form to 
EMATEK GmbH                    Support: gsscgi@ematek.de
Subbelrather Strasse 17        Phone:   (+49) 221-512074
                               Fax:     (+49) 221-529666
D - 50823 Koeln                BBS:     (+49) 221-5101560